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Many insurance companies insist that a person suffering from fibromyalgia must provide “objective evidence” of disability in order to qualify for disability benefits.  A number of federal decisions, however, make very clear that a person seeking disability benefits for fibromyalgia need not establish “objective evidence” of disability. In Hawkins v. First Union Corp. Long-Term Disability Plan, […]

When an insurance company denies a claim, it will purport to state the reasons on which it bases its denial.  The insurance company’s reasons are all too often no more than a pretext for denying a claim it knows it should pay.  If the case proceeds to litigation, the insurance company will then assert any […]

When an insurance company or ERISA plan denies your disability claim, it often leaves you with more questions than answers.  You will likely receive a letter littered with conclusions as to why you are not disabled without any reasoned explanation as to why you do not qualify.  The law is clear, however, that an ERISA […]

Under California law, a private citizen can bring a lawsuit specifically intended to address the ills or injustices in society.  Recognizing that such lawsuits are highly risky and may be prohibitively expensive, in 1977, California passed a law often referred to as the Private Attorney General’s Act (“PAGA”).  Under PAGA, found at California Code of […]

When an insurance company denies a claim, it will often summarize in its denial letter the evidence cited by the insured in support of the claim.  The insurance company will do so in order to attempt to create an appearance that it actually reviewed and considered in good faith the evidence contrary to its decision.  […]

California case law is clear that an insured’s attempt to return work may not bar a finding of disability.  The California courts have long recognized that people who are struggling with pain and other symptoms will nevertheless attempt to work.  In recognizing that people may continue perform job duties that endanger their health, courts have […]

Some disability insurance policies include a provision that the insurer will try to use to disregard the insured’s actual job duties in deciding whether the insured is disabled.  A number of these policies, especially those sold by Standard Insurance Company, contain language that states that, in deciding whether to pay the claim, the insurer can […]

In the recent case of Backman v. Unum Life Ins. Co. of Am., 2016 U.S. Dist. LEXIS 74918 (N.D. Cal. June 8, 2016), in which the claimant sought disability benefits for a painful back injury, the US District Court for the Northern District reversed Unum’s denial and ordered the payment of benefits. Unum had denied benefits based on the opinions […]

In ERISA claims, disability insurance companies often state in their denial letters that the insured does not qualify for benefits because he has not stated “objective evidence” of disability. However, case law in the 9th Circuit and elsewhere is clear that an ERISA insurer cannot properly insist on proof with “objective evidence” if the condition is one for which […]

If your insurance company denies your disability insurance claim and your case is governed by California law, proving “bad faith” is a two-step process. You must first establish that you are disabled under California law. In other words, you must first establish that, under California law, you are entitled to the disability benefit under the […]